Provider Demographics
NPI:1881945343
Name:VALLE, JESSICA LAUREN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:VALLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 ROUTE 59
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5204
Mailing Address - Country:US
Mailing Address - Phone:845-357-7277
Mailing Address - Fax:845-357-5516
Practice Address - Street 1:222 ROUTE 59
Practice Address - Street 2:SUITE 109
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5204
Practice Address - Country:US
Practice Address - Phone:845-357-7277
Practice Address - Fax:845-357-5516
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NY016056-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical